Plan B: My politically incorrect take on the news

Protest over Savita Halappanavar's death - separation of Church and State

Sometimes I feel like Alice in Wonderland, staring into distorting mirrors. The ongoing fight over Plan B has again precipitated this disquieting feeling. There is such a disconnect between some stated outcomes that are claimed as being desirable and actions that don't support that. In this case, probably most people would agree that elective abortions are unfortunate and not a desirable outcome. But how different sides would approach this problem are at polar opposites.

For example, conservative folks on the political right are using draconian measures of banning abortions—even if the mother's life is at risk—and attacking clinics and murdering health care workers, at the same time as euphemistically proclaiming themselves “pro-life.” “Small government” proponents want to insert themselves into every aspect of a woman's life and health, including via intrusive, medically unnecessary vaginal ultrasounds, psychological duress, and insanely stupid debates about “legitimate” rape. In contrast, many of us who are more liberal, focus our efforts on reducing the need for abortion, aiming to achieve this goal by providing education and family planning services.

Also, on the one hand, we are asking physicians to practice more evidence-based medicine, at the same time as, in the area of women's reproduction at least, politicians are tying their hands.

Memorial rally in Dublin for Savita Halappanavar and women's rights

This issue has resurfaced in recent weeks, first with the tragic and senseless death of Savita Halappanavar, a 31 year old Hindu woman who had the misfortune to have a miscarriage “treated” in an Irish hospital imposing barbaric and antiquated Catholic doctrines on her. As well described by Dr. Jen Gunter, physicians did not perform a medically necessary abortion on a non-viable fetus, instead choosing to let a woman die painfully and needlessly from overwhelming sepsis.

The irrational decision to overrule the recommendation of numerous experts appears to be based on the idea that young girls would be buying the pill without parental consent, and that such girls could not do so safely. They ignore that kids can readily buy Tylenol, which has significant liver toxicity and is often a component of deadly drug overdoses. Plan B is far safer—and also unlikely to be used routinely because, at ~$50, it is relatively expensive. They ignore the dangers of pregnancy, which are far greater...or the dangers of a teen suffering from rape or abusive parents, who certainly doesn't need the added trauma of an unwanted pregnancy.

President Obama expressed his concern as a parent, that his daughters must not have access to such a medicine without adult guidance. That may be true in an ideal world, but it is neither practical, nor does it bear any resemblance to the realities of many teens' lives. The US has a higher teen pregancy rate than any other developed western country, with five times the teen birthrate in France and 2 1/2 times the rate in Canada. “Only half of the nation’s teen moms ever earn a diploma; more than half go on welfare; and more than half of the families started by teens live in poverty,” according to “Sacrificing ‘Change We Can Believe In’ for Expediency?”According to a pediatrician author of the new AAP policy, teen pregnancy perpetuates a cycle of poverty and problems, as these babies perform more poorly in school and tend to have ongoing behavior problems.

Given the safety data, the lingering educational and economic harm and the huge personal toll of unexpected and unwanted pregnancies, I am disappointed that the AAP did not go further in their recommendation. It is unrealistic to expect teens to be able to get a prescription from their physicians for emergency contraceptives. Many teens do not have access to regular medical care. Instead, the AAP and ACOG should strongly back the FDA, who already recommended OTC status for the drug for teens. And we should all send a strong message to President Obama: decisions should be based on science, not politics. You have been re-elected. Stand up and don't overrule the FDA and data on this public health and economic issue. Make emergency contraception available to all, regardless of age.

Updates 11/30/12:

See my comments in response to a reader for further information about the application of the Catholic religious directives during miscarriages.

Comments

Welcome to the Scientific American Blog Network, a forum for a diverse and independent set of voices to share news and opinions and discuss issues related to science. For more information see our About page and Guidelines....more